Dr. Sonja Van Hala on Physician Wellness in Residency Programs

Sonja Van Hala, MD, MPH, FAAFP, has been the Residency Program Director for the University of Utah Family Medicine Residency Program for nearly 12 years –and is an advocate for physician wellness.

Van Hala’s interest in physician wellness came from a very personal place. She joined the faculty right out of residency. “I was working too much, compulsive, perfectionistic, and stressed. I was suffering. My marriage was suffering. Then I became program director.” “I had put off having children during medical school and residency. I told myself, ‘What am I waiting for? I just have to do it.’ I started my family one year in to my role as program director.”

During her maternity leave she had a great group of partners who filled in while she was away. One of her colleagues had advised her to take the full 12 weeks, saying “Your partners will soon forget that you were on leave for three months, but you will always remember being with your baby.” That was an influential realization that she had the power to make choices that support her wellness.

Shortly after returning to work, she began learning more about physician wellness. “I started looking at myself and how we train. I had to be a role model. I have a responsibility to set our values and culture. I realized that wellness is as important as anything else learned in medical school or residency.”

Then, through NIPPD, she attended a presentation by the late Lee Lipsenthal, MD. “He demonstrated how stress translates into neurochemical changes that harm our health. Then he taught techniques for stress management. His teachings imprinted upon me the physiologic importance of wellness,” said Van Hala. Up until then, her mantra had always been to work harder. “He showed me that there was another way.”

She began adding wellness initiatives to her program. “It took a while to get some policies and systems in place,” Van Hala said. Five years ago, psychologist Katherine Fortenberry, PhD, came on board and together she and Van Hala worked earnestly toward making wellness an integral part of the residency culture. The two were planning and building as the national conversation about physician wellness began to swell.

Establishing and maintaining a wellness program takes time and intention. She points out that it is critical to look within your own residency. What needs attention? What’s broken? If you don’t know, ask! Ask your residents. Ask them in a way that they know that it’s okay to talk about it. Van Hala used a nominal group technique with her residents to create an exhaustive list of ideas to improve resident wellness, which were then narrowed down through votes. Some of these ideas could be implemented right away. Some ideas clarified the ‘pressure points’ that residents experience.

“Residents are the consumers. They are in the trenches. We should encourage them to identify opportunities and solutions,” Van Hala says. “We should also encourage residents to show kindness and compassion for each other and for themselves. Residency is hard.”

Van Hala’s intention was to make wellness part of her residency’s culture. A focus group of her residents, conducted by an outside facilitator, demonstrated that they had succeeded. One resident commented: “I think one big positive step that this program has already achieved is that the program thinks about it [wellness]…There are a lot of other programs where wellness is just not even in their vocabulary. I think programs need to have that on their radar as a priority, which I think that this program does better than others.”

Van Hala tells program directors striving to create a wellness focus, “Recognize the authority you have – and use it. For instance, we can determine clinic and rotation schedules, ensure residents take vacation and sick time, and create a means to give anonymous feedback.”

Her wellness efforts have not been without setbacks. An institutional GME wellness survey indicated that the results at her program were not all that different from other programs. However, the University of Utah has made a commitment to wellness, appointing a Chief Wellness Officer and developing a GME Wellness Program. Van Hala understands there is still much work to be done. “Are we measuring the right thing? I suspect we are not. Also, we’re probably not going to have wellness solved until we address big issues people don’t want to talk about. The norms of being a physician are warped. Workaholic behavior is big issue. A lot of people working pretty crazily – and we are training residents in this environment,” Van Hala said. However, in the younger generations, she sees hope, “The martyr is no longer thought of as the place to be. Millennials are pushing this agenda.”

Today, when interviewing medical students for residency, Van Hala stresses that wellness is part of the education and culture at her program. At the end of residency, she provides each of her graduates with the book, “The Resilient Physician” by Sotile and Sotile. She uses exercises from the book during their annual residency retreats. “It’s a great resource for self-reflection on how our traits, work and life intersect and how to cultivate resilience,” she said.

You can’t create a culture of wellness if you aren’t taking care of yourself – exercising, eating well, sleeping enough, and living according to your values. “Look at your values. Make sure your compass is pointed in right direction. Develop time management, delegation, and teambuilding skills. Create policies and structures to handle challenges that come up. Make sure you have a support network; leadership can be isolating,” She recommends NIPPD, PDW, Crucial Conversations, professional coaching, meditation and therapy.

Van Hala believes in the need to put attention to faculty satisfaction and wellness, as it comes up consistently. “It would be ideal to have a wellness program for faculty as we do for the residents. A trickle up affect,” she says. The beginnings of such efforts are underway.